U.S. patent number 9,131,937 [Application Number 13/674,825] was granted by the patent office on 2015-09-15 for suture anchor.
This patent grant is currently assigned to VentureMD Innovations, LLC. The grantee listed for this patent is VentureMD Innovations, LLC. Invention is credited to Kwan-Ho Chan, T. Wade Fallin, James Murphy, Patrick Michel White.
United States Patent |
9,131,937 |
Chan , et al. |
September 15, 2015 |
Suture anchor
Abstract
Suture anchors are disclosed having suture locking features able
to lock multiple suture ends extending from a body tissue, such as
from a bone tunnel, with a single device.
Inventors: |
Chan; Kwan-Ho (Singapore,
SG), Murphy; James (Newton Square, PA), Fallin; T.
Wade (Hyde Park, UT), White; Patrick Michel (West
Chester, PA) |
Applicant: |
Name |
City |
State |
Country |
Type |
VentureMD Innovations, LLC |
North Logan |
UT |
US |
|
|
Assignee: |
VentureMD Innovations, LLC
(Logan, UT)
|
Family
ID: |
48281333 |
Appl.
No.: |
13/674,825 |
Filed: |
November 12, 2012 |
Prior Publication Data
|
|
|
|
Document
Identifier |
Publication Date |
|
US 20130123842 A1 |
May 16, 2013 |
|
Related U.S. Patent Documents
|
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
Issue Date |
|
|
61560694 |
Nov 16, 2011 |
|
|
|
|
61597138 |
Feb 9, 2012 |
|
|
|
|
Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B
17/0401 (20130101); A61B 2017/0409 (20130101); A61B
2017/0414 (20130101); A61B 2017/044 (20130101); A61B
2017/0412 (20130101); A61B 2017/0451 (20130101); A61B
2017/0441 (20130101); A61B 2017/0445 (20130101); A61B
2017/0459 (20130101) |
Current International
Class: |
A61B
17/04 (20060101) |
Field of
Search: |
;606/232 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
|
|
|
|
|
|
|
2070481 |
|
Jun 2009 |
|
EP |
|
WO2010/132310 |
|
Nov 2010 |
|
WO |
|
WO 2011/008607 |
|
Jan 2011 |
|
WO |
|
WO 2012/007941 |
|
Jan 2012 |
|
WO |
|
WO 2013/027209 |
|
Feb 2013 |
|
WO |
|
WO 2013/027210 |
|
Feb 2013 |
|
WO |
|
Other References
"Arthrex PassPort Button Cannula" (2011) Arthrex, Inc., 6pgs.
www.arthrex.com. cited by applicant .
"Arthroscopic Shoulder Repair Using the Smith & Nephew
Footprint PK Suture Anchor" (2008) Smith & Nephew, Inc., 12pgs.
cited by applicant .
"CurvTek Bone Tunneling System" (2000) Arthrotek, Inc., 6pgs. cited
by applicant .
"The OPUS.RTM. AutoCuff.RTM. System Featuring SpeeScrewTM for
Rotator Cuff Repair" (2009) Arthrocare Corporation, 8pgs. cited by
applicant .
ArthroCare Sports Medicine International, Products: SpeedStitch
MagnumWire Suture Cartridges, (3ea: white & co-braid),
http://www.arthrocaresportsmedicine.com/products/view/435 Sep. 24,
2012, 1pg. cited by applicant .
ArthroCare Sports Medicine International, Products: SpeedStitch
Suturing Device,
http://www.arthrocaresportsmedicine.com/products/view/431 Sep. 24,
2012, 1pg. cited by applicant .
Baums, et al. "Tendon-bone contact pressure and biomechanical
evaluation of a modified suture-bridge technique for rotator cuff
repair" Knee Surg Sports Traumatol Arthrosc (2010) 18:992-998.
cited by applicant .
Dermirhan, et al. "Current Concept: Arthroscopic Transosseous
Equivalent Suture Bridge Rotator Cuff Repair" (2012) 109-115,
Springer-Verlag Berlin Heidelberg. cited by applicant .
Lorbach and Tompkings "Rotator Cuff: Biology and Current
Arthroscopic Techniques" Knee Surg Sports Traumatol Arthrosc,
Springer-Verlag, published online: Jan. 21, 2012, 9pgs. cited by
applicant .
Maguire, et al. "Biomechanical Evaluation of Four Different
Transosseous-equivalent/suture Bridge Rotator Cuff Repairs" Knee
Surg Sports Traumatol Arhtrosc (2011) 19:1582-1587. cited by
applicant .
Park, et al. "Part I: Footprint Contact Characteristics for a
Transosseous-equivalent Rotator Cuff Repair Technique Compared with
a Double-row Repair Technique" J.Shoulder Elbow Surg (2007)
16(4):461-468. cited by applicant .
Upper Limb Surgery Info., Adelaide--Wakefield Orthopaedic Clinic,
SA, Jan. 30, 2012, 4pgs.
http://www.woc.com.au/upper-limb-research.html. cited by applicant
.
VersalokTM The Next Generation in Rotator Cuff Repair, (2007) DePuy
Mitek, Inc., www.depuymitek.com, 18pgs. cited by applicant.
|
Primary Examiner: Severson; Ryan
Assistant Examiner: Knauss; Christian
Parent Case Text
CROSS-REFERENCE TO RELATED APPLICATIONS
This application claims the benefit of U.S. Provisional Application
No. 61/560,694, filed Nov. 16, 2011, and U.S. Provisional
Application No. 61/597,138, filed Feb. 9, 2012, both of which are
hereby incorporated by reference.
Claims
What is claimed is:
1. A suture anchor for securing first and second suture portions
relative to a bone, the suture anchor comprising: an elongated body
defining a longitudinal axis extending between a first end and a
second end; a proximal portion having first suture securing means
for securing the first suture portion; and a distal portion having
second suture securing means for securing the second suture
portion, the first and second suture securing means being spaced
apart relative to the longitudinal axis.
2. The suture anchor of claim 1 wherein the proximal portion is a
proximal one half of the suture anchor and the distal portion is a
distal one half of the suture anchor.
3. The suture anchor of claim 1 wherein the proximal portion is a
proximal one third of the suture anchor and the distal portion is a
distal two thirds of the suture anchor.
4. The suture anchor of claim 1 wherein the proximal portion is a
proximal two thirds of the suture anchor and the distal portion is
a distal one third of the suture anchor.
Description
FIELD OF THE INVENTION
The invention relates to suture anchors and their method of
use.
BACKGROUND
A variety of surgical procedures require the attachment of
something relative to a surgical site. For example, in surgery
relating to the skeletal system, it is often advantageous to attach
soft tissue, suture, implants, and/or other items in or adjacent to
a joint. For example, ligaments, tendons, fascia, other capsular
material, and/or muscle may be attached to an adjacent bone to
affect a repair of a joint. Such joints may include any joint in a
patient's body such as the joints of the hands and feet, ankle,
wrist, knee, elbow, hip, shoulder, and spine. For example, it is
often advantageous to pass a suture through a portion of a bone to
form a transosseous attachment to the bone.
SUMMARY
Aspects of the invention provide devices and methods to attach one
or more sutures to a bone.
In one aspect of the invention, a suture anchor includes a suture
retaining feature or features able to retain first and second
portions of a suture passed transosseously through a bone. For
example, a suture passing through a bone may have first and second
free portions and a single suture anchor according to the present
invention may include a suture retaining feature able to secure
both free portions of the suture to the bone. In another example, a
single suture anchor may include multiple suture retaining features
able to secure both free portions of the suture to a bone.
In another aspect of the invention, a suture anchor includes a
first body able to receive a portion of a suture in relative
sliding relationship and a second body receivable by the first body
to lock the portion relative to the first body. The second body may
lock the portion of suture by trapping the portion between the
first and second bodies. The portion of suture may include a single
end, a pair of ends, a bight, or other portion of the suture.
In another aspect of the invention, a suture anchor includes a
first body able to receive first and second portions of a suture in
relative sliding relationship. A second body is receivable by the
first body to lock the first and second portions relative to the
first body. The second body may lock the first and second portions
one at a time or simultaneously. The second body may lock the first
and second portions at a single position on the first body or at
separate discrete positions on the first body. For example, first
and second portions of a suture may be placed through an opening in
the first body and simultaneously locked by trapping the portions
between the first and second body. In another example, first and
second portions of a suture may be placed through separate openings
in the first body and simultaneously locked. In another example,
first and second portions of a suture may be placed through
separate openings in the first body and sequentially locked.
In another aspect of the invention, a suture anchor includes a
first body having a suture retainer and a suture includes at least
one loop engageable with the suture retainer.
BRIEF DESCRIPTION OF THE DRAWINGS
Various examples of the present invention will be discussed with
reference to the appended drawings. These drawings depict only
illustrative examples of the invention and are not to be considered
limiting of its scope.
FIG. 1 is a partial side sectional view of an illustrative implant
and method according to the present invention;
FIGS. 2 and 3 are partial side sectional views of an illustrative
implant and method according to the present invention;
FIGS. 4 and 5 are partial side sectional views of an illustrative
implant and method according to the present invention;
FIG. 6 is a partial side sectional view of an illustrative implant
and method according to the present invention;
FIG. 7 is a partial side sectional view of an illustrative implant
and method according to the present invention;
FIG. 8 is a partial side sectional view of the implant of FIG. 7 in
use in an alternative method;
FIG. 9 is a partial side sectional view of an illustrative implant
and method according to the present invention;
FIG. 10 is a perspective view of an illustrative implant according
to the present invention;
FIG. 11 is a perspective view of the implant of FIG. 10;
FIG. 12 is a side elevation view of the implant of FIG. 10;
FIGS. 13-15 are sectional views taken along line 13-13 of FIG. 12
showing an aspect of the operation of the implant of FIG. 10;
FIGS. 16-20 are partial side sectional views showing a method of
using the implant of FIG. 10;
FIG. 21 is a partial side sectional view of the implant of FIG. 10
in use in an alternative method.
DESCRIPTION OF THE ILLUSTRATIVE EXAMPLES
Minimally invasive surgery is surgery used to gain access to deeper
parts of the human body through small incisions. Such surgery may
range from mini-open surgery to arthroscopic surgery. Mini-open
surgery is generally understood to mean surgery performed through
small incision(s) under direct vision as opposed to arthroscopic
(or endoscopic) surgery where surgery is performed through one or
more stab incisions in which the arthroscope (or endoscope) is used
for visualization. In arthroscopic surgeries, the size of the stab
incisions generally range from 1 mm to 10 mm. The illustrative
examples depict arthroscopic surgical techniques but it is to be
understood that the techniques could be performed in any minimally
invasive or open technique. The following illustrative examples
depict implants and techniques to pass a suture through a portion
of the head of the humeral bone at the shoulder of a human patient
and fix the suture there to repair damaged soft tissue associated
with the shoulder joint. Instruments and techniques according to
the present invention may be used to anchor a suture to any bone,
at surgical sites anywhere in a patient's body, and for any
purpose. The terms "suture" and "suture strand" are used herein to
mean any strand or flexible member, natural or synthetic, able to
be passed through a bone tunnel and useful in a surgical procedure.
The term "transverse" is used herein to mean to cross at an angle;
i.e. not parallel. The term includes, but is not limited to right
angles. The term "bight" is used herein to mean a bend or loop
formed in the intermediate portion of a suture.
A human left shoulder joint is used to provide context for
illustrative examples of a surgical technique. The subacromial
space, between the humeral head and the undersurface of the
acromion, is a potential space for surgical repair. This space is
partially occupied by the subacromial bursa. Soft tissue layers
overlie the shoulder joint. These layers define a soft tissue zone
including the skin, subcutaneous tissue, muscles and bursal tissue.
Instruments are inserted through the soft tissue zone via stab
incisions and access canulae can be inserted through these stab
incisions to facilitate the insertion and withdrawal of surgical
instruments. The thickness of this soft tissue zone varies by
patient and by location from a few millimeters to several
centimeters.
Referring to FIG. 1 an osseous attachment device includes an
implant 100 having an elongated shaft 102 extending from a proximal
end 104 to a distal end 106 along an axis 108. The shaft 102
engages an elongated flexible strand to hold it relative to a bone.
For example, FIG. 1 depicts a bone 120 and soft tissue 122 to be
attached to the bone 120 adjacent a skeletal joint; e.g. a proximal
humerus and a portion of a rotator cuff. An elongate flexible
strand 124 such as a suture having first and second ends 126, 128
is passed through the soft tissue 122 and into the bone 120 at a
desired attachment site. The implant 100 is inserted into the bone
120 to capture and retain the ends 126, 128 to hold the soft tissue
122 adjacent the bone 120.
For example, in a shoulder repair procedure, an elongate strand 124
in the form of at least one closed suture loop may be passed
through the soft tissue 122 of the rotator cuff and the first end
126 of the loop placed in the bone 120 such as by placing it into a
preformed tunnel or impacting it into the bone on a driver to
simultaneously form a tunnel and insert the first end 126. In the
illustrative embodiment of FIG. 1, the first end 126 is positioned
in first tunnel 129. A hook 110 is formed adjacent the proximal end
104 of the implant 100 with a hook opening facing distally. The
hook 110 is engaged with the second end 128 and inserted into the
bone along a path intersecting the first end 126. The implant 100
and second end 128 may for example be impacted directly into the
bone to simultaneously form a second tunnel 130 and insert the
implant, or alternatively, they may be inserted into a preformed
tunnel. In the illustrative embodiment of FIG. 1, one or more,
optional barbs 112 project from the shaft 102 outwardly and
distally. When the implant 100 intersects the first end 126, one or
more of the barbs 112 engage the first end 126 such that when
insertion of the implant 100 is complete, the implant 100 engages
and secures both ends of the elongate strand 124 to retain the
elongate strand in the bone 120 and secure the soft tissue 122 with
the first end being secured distally and the second end being
secured proximally. Alternatively, the barbs 112 may be omitted and
the shaft 102 alone pass through the suture loop to constrain it
within the bone. With the use of a preformed loop, the soft tissue
attachment is accomplished without the need for the user to tie any
knots.
Referring to FIGS. 2 and 3, an osseous attachment device includes a
locking implant 200 and an elongated member 220. In the
illustrative embodiment of FIGS. 2 and 3, the implant 200 is in the
form of an interference screw. The implant 200 includes an
elongated tapered body 202 extending from a wider, proximal end 204
to a narrower, distal end 206 along an axis 208. A spiral thread
210 is formed on the exterior of the body 202 and the body includes
an axial through passage 212. In the illustrative embodiment of
FIG. 2, the separate elongated member 220 is in the form of a
suture carrier that includes an elongated shaft 222 extending from
a proximal end 224 to a distal end 226. The distal end 226 may be
tapered or otherwise sharpened to ease insertion into bone. A
transverse opening 230 is formed through the shaft near the distal
end 226. An optional groove or reduced diameter region may be
provided proximal of the opening 230 to ease in cutting or breaking
the elongated member 220 to a desired length. The passage 212 of
the implant and shaft 222 of the elongated member are sized for
axial translating engagement. The elongated member 220 is used to
capture the ends of an elongated flexible strand and the implant
200 is used to lock the elongated flexible strand to hold the
elongated flexible strand adjacent to a bone.
For example, in a shoulder repair procedure, an elongate strand 240
in the form of at least one suture defining a first end 242 in the
form of a loop, or bight, and having second ends 244, may be passed
through the soft tissue 246 of the rotator cuff. The first end 242
is inserted into the bone 248 such as by placing it into a
preformed tunnel 243 or impacting the elongate strand 240 into the
bone on a driver to simultaneously form a first tunnel and insert
the first end 242. The second ends 244 are passed through the
transverse opening 230 of the elongated member 220 and the
elongated member 220 and second ends 244 are inserted into the bone
along a path that intersects the first end 242. The elongated
member 220 and second ends 244 may for example be impacted directly
into the bone to simultaneously form a second tunnel and insert
elongated member 220 and second ends 244, or alternatively, they
may be inserted into a preformed second tunnel 245. When the
elongated member 220 intersects the first end 242, the distal end
226 of the elongated member 220 captures the first end 242 distally
and prevents it from being withdrawn upwardly through the bone such
that the first end 242 is retained distally in the bone. The second
ends 244 may then be pulled to feed slack through the transverse
opening 230 and tension the elongated strand 240 and approximate
the soft tissue to the bone. The locking implant 200 is then
engaged with the proximal end of the elongated member 220 and
advanced into the bone 248. The locking implant 200 presses the
elongated strand 240 against the bone in an interference engagement
to lock the second ends 244 in the second tunnel 245. The locking
implant also prevents the elongated member 220 from exiting the
second tunnel 245 thus the locking implant locks both ends of the
elongated strand 240 relative to the bone 248 and secures the soft
tissue 246. The soft tissue attachment is accomplished without the
need for the user to tie any knots.
Referring to FIGS. 4 and 5, an osseous attachment device includes a
locking implant 300 and a suture carrier 320 similar to that of
FIGS. 2 and 3. In the illustrative embodiment of FIGS. 4 and 5, the
implant 300 is in the form of an interference screw having a
cylindrical body 302 extending from a proximal end 304 to a distal
end 306 along an axis 308. A spiral thread 310 is formed on the
exterior of the body 302. In the illustrative embodiment of FIGS. 4
and 5, the separate suture carrier 320 is in the form of a ring
having an aperture 322. The suture carrier 320 is used to capture
the ends of an elongated flexible strand and the locking implant
300 is used to lock the elongated flexible strand to hold the
elongated flexible strand adjacent to a bone. While a suture
carrier has been shown in the form of a ring it may have other
forms such as a sphere, rod, or other suitable shape that can
receive a suture in sliding relationship.
For example, in a shoulder repair procedure, as shown in FIGS. 4
and 5, an elongate strand 340 in the form of at least one suture
defining a first end 342 in the form of a loop, or bight, and
having second ends 344, may be passed through the soft tissue 346
of the rotator cuff. The first end 342 is inserted into the bone
348 such as by placing it into a preformed first tunnel 343 or
impacting the elongate strand 340 into the bone on a driver to
simultaneously form a tunnel and insert the first end 342. The
second ends 344 are passed through the aperture 322 of the suture
carrier 320 and the suture carrier 320 and second ends 344 are
inserted into the bone along a path that intersects the first end
342. The suture carrier 320 and second ends 344 are passed through
the loop of the first end 342. Applying tension to the elongated
strand 340 causes the loop of the first end 342 to close around the
second ends 344 and trap the suture carrier 320 in the bone such
that the ends 342, 344 are retained in the bone. Further pulling on
the second end 344 causes slack to feed through the suture carrier
and tension the strand 340 to approximate the soft tissue to the
bone. The locking implant 300 is then advanced into the bone 348.
The locking implant 300 presses the elongated strand 340 against
the bone in an interference engagement to lock the elongated strand
340 relative to the bone 348 and secure the soft tissue 346. The
soft tissue attachment is accomplished without the need for the
user to tie any knots.
Referring to FIG. 6, an osseous attachment device includes an
implant 400. In the illustrative embodiment of FIG. 6, the implant
400 is in the form of an interference screw. The implant 400
includes an elongated body 402 extending from a proximal end 404 to
a distal end 406 along an axis 408. A spiral thread 410 is formed
on the exterior of the body 402. A head 412 is formed near the
proximal end 404 and defines a distally facing shoulder 414 at the
junction of the head 412 and body 402. The implant 400 is used to
capture both ends of an elongated flexible strand 420 and hold the
elongated flexible strand 420 adjacent to a bone.
For example, in a shoulder repair procedure, as shown in FIG. 6, an
elongated strand 420 in the form of at least one suture having
first ends 422 and a second end 424 defining a loop, may be passed
through the soft tissue 426 of the rotator cuff. The first end 422
is inserted through the bone 428. The second end 424 is engaged
with the distal end 406 of the implant 400. The first end 422 may
be tensioned to remove slack and press the soft tissue against the
bone. The distal end 406 of the implant 400 may be braced against
the bone or engaged with the bone tunnel to facilitate tensioning
the strand 420. The implant 400 is then driven into the bone to
lock the ends 422, 424 relative to the bone. The second end 424 is
trapped beneath the head 412 adjacent the shoulder 414 of the
implant 400 and the first end is trapped between the thread 410 and
bone 428.
Referring to FIGS. 7 and 8, an osseous attachment device includes
an implant 500. The implant includes an elongated body 502
extending from a proximal end 504 to a distal end 506 along an axis
508. An axial bore 510 extends into the body 502 proximally to
distally. A transverse body aperture 512 extends through the body
and intersects the axial bore 510. A head 514 is formed near the
proximal end 504 and defines a distally facing shoulder 516 at the
junction of the head 514 and body 502. The head 514 is interrupted
by opposed grooves aligned with the aperture 512. Opposed flat
surfaces 518 on the exterior of the body are aligned with the
grooves and the aperture 512 and the grooves and flat surfaces 518
provide clearance to allow a suture to slide between the body 502
and a bone tunnel wall. The exterior of the body further includes
annular projections 520 on opposite sides of the body 502 between
the flat surfaces 518. The annular projections engage a bone tunnel
wall to retain the implant 500 in the bone tunnel. The axial bore
510 is threaded proximally and receives a piston-like plunger 522
in axial threaded engagement such that the plunger is responsive to
rotation to move between a first position in which the plunger 522
distal end is substantially not overlapping the transverse body
aperture 512 and a second position in which the plunger 522
overlaps at least a portion of the transverse body aperture
512.
The implant 500 is used to capture both ends of a strand and hold
the strand adjacent to a bone. For example, in a shoulder repair
procedure, as shown in FIG. 7, an elongated strand 550 in the form
of at least one suture having a first end 552 and a second end 554
defining a loop, may be passed through the soft tissue 556 of the
rotator cuff. The first end 552 is inserted through the bone 558.
The second end 554 is looped around the body 502 such as by
inserting the implant 500 through the loop of the second end 554
until the loop comes to rest against the shoulder 516. The first
end 552 is passed through the aperture 512. The first end is then
passed along the flat surface 518 and through the groove in the
head. The implant 500 is inserted into the bone until the shoulder
516 abuts the bone 558. The first end 552 of the strand 550 is
tensioned to remove slack and press the soft tissue against the
bone. The plunger 522 is advanced toward the transverse aperture
512 until the distal end of the plunger 522 traps the second end
554 of the strand in the axial bore 510 such that the first end 552
is fixed distally in the aperture 512 and the second end 554 is
trapped proximally under the shoulder 516.
FIG. 8 illustrates an alternative method of using the implant 500.
In the illustrative method of FIG. 8, both ends 552, 554 of the
suture are passed through the transverse aperture 512 of the
implant 500 and along the flat surface 518 and through the groove
in the head. The implant 500 is inserted into the bone until the
shoulder 516 abuts the bone 558. The ends 552, 554 of the strand
550 are tensioned to remove slack and press the soft tissue against
the bone. The plunger 522 is advanced toward the transverse
aperture 512 until the distal end of the plunger 522 traps the ends
552, 554 of the strand distally in the aperture 512 intersecting
the axial bore.
Referring to FIG. 9, an osseous attachment device includes an
implant 600 similar to that of FIGS. 7 and 8 except that the
implant 600 of FIG. 9 includes a transverse aperture 602 through
the implant body 604 and a transverse aperture 606 through the
plunger 608 and the plunger 608 is advanced by pressing it into the
body 604 rather than by threading. In this example, the first end
610 of the suture strand is passed through the body aperture 602
and the second end 612 is passed through the plunger aperture 606.
When the plunger 608 is advanced in the body 604, the distal end of
the plunger traps the first end 610 in the body aperture 602 and
the plunger aperture 606 and head 614 trap the second end 612. The
relationship between the plunger length and positions of the
apertures 602, 606 may be adjusted to provide for simultaneous
locking of the suture ends, distal locking of the first suture end
610 before proximal locking of the second suture end 612, or
proximal locking of the second suture end 612 before distal locking
of the first suture end 610.
Referring to FIGS. 10-15, an osseous attachment device includes an
elongate implant body 700 and a plunger 750 receivable in the body
700. The implant body extends from a proximal end 702 to a distal
end 704 along an axis 706. An axial passage 708 extends into the
body proximally to distally along the axis 706. First and second
transverse apertures 710, 712, forming a distal aperture pair,
extend through the body 700 distally and intersect the axial
passage 708. The apertures 710, 712 are offset toward opposite
sides of the axis 706 and the second aperture 712 is offset
proximally from the first aperture 710. Third and fourth transverse
apertures 714, 716, forming a proximal aperture pair, extend
through the body 700 proximally and intersect the axial passage
708. The apertures 714, 716 are offset toward opposite sides of the
axis 706 and the fourth aperture 716 is offset distally from the
third aperture 714. The body 700 has radially extending ridges 718
that taper distally to aid in retaining the body in a tunnel.
Opposed flats 720, 722 extend along opposite sides of the body 700
adjacent the apertures 710, 712, 714, 716 to provide clearance for
suture ends extending alongside the body 700. A head 724 formed
near the proximal end extends radially outwardly beyond the body
diameter and includes radially extending ridges 726. Opposed flats
728, 730 extend along opposite sides of the head 724 in
circumferential alignment with the body flats 720, 722 and
apertures 710, 712, 714, 716 but spaced radially outwardly from the
axis 706 farther than the flats 720 and 722. Alignment slots 732,
734 are formed on the distal end of the head to provide a
rotational alignment keyway for a driver (not shown). The distal
end 704 of the body tapers distally to ease insertion into a
tunnel.
The plunger 750 includes an elongated body 752 extending from a
proximal end 754 to a distal end 756 along an axis 758. The distal
end of the plunger tapers distally to ease insertion into the body
700 and separate suture strands as will be more fully described
below. The plunger 750 has faceted sides 705 defining elongated
vertices, or ridges 707, at the intersection of adjacent facets.
The plunger 750 is receivable in the passage 708 in axial
translating relationship.
One or more suture strands may be passed through the apertures 710,
712, 714, 716 and locked with the plunger 750. The plunger can lock
any number of suture strands passing through any number of the
apertures. Referring to FIG. 13, a suture strand 760, 762 has been
passed through each of apertures 710 and 712. The plunger 750 has
been advanced distally into the passage 708 until the distal end
756 of the plunger 750 is just short of touching the suture strands
760, 762. As can be seen in FIG. 13, since the apertures 710, 712
are offset outwardly from the axis 706, the tapered distal end 756
of the plunger, which is coaxial with axis 706, is directed between
the strands 760, 762.
Referring to FIG. 14, the plunger has been advanced further
distally and the distal end 756 has moved between the strands 760,
762 and begun pressing them outwardly toward the side wall of
passage 708.
Referring to FIG. 15, the plunger 750 has been advanced fully into
the passage 708 and tightly compresses the strands 760, 762 between
the plunger sides and passage 708 such that the suture strands are
locked firmly relative to the body 700. The plunger 750 presses the
strands sideways into the sidewall of passage 708 and the suture
strands are highly compressed by the ridges 707. Since the ridges
707 are able to slide smoothly over the sutures while compressing
them, the advancing plunger 750 locks the suture strands without
dragging the sutures substantially axially along the passage 708
and therefore the suture strands are locked with little or no
change in the suture tension.
FIGS. 16-19 depict an illustrative example of a method of using the
implant of FIGS. 10-15 in a surgical procedure to secure a portion
of a rotator cuff to a proximal humerus using knotless transosseous
suture fixation.
Referring to FIG. 16, first and second intersecting bone tunnels
770, 772 have been formed in the head of a humeral bone 774 of a
shoulder joint. Suture strands 776 have been passed through the
bone tunnels with first ends 780 exiting superiorly from the first
bone tunnel and passing through a portion of the rotator cuff 778
and second ends 782 exiting laterally from the second bone tunnel
772. The first ends 780 have been passed through the proximal
apertures 714, 716 of the implant body 700 and the second ends 782
have been passed through the distal apertures 710, 712. The second
bone tunnel 772 is sized to be a press fit with the ridges 718 of
the body 700.
Referring to FIG. 17, the body 700 has been inserted into the
second bone tunnel 772 up to the base of the head 724. In this
position, the suture ends 780, 782 may be pulled to remove slack
from the suture strands 776 and the strands will slide easily
through the bone tunnels and implant body 700.
Referring to FIG. 18, the body 700 has been further inserted into
the second bone tunnel 772 so that the head is flush with the bone
and the head compresses the suture strands between the head and
bone. Since the head 724 extends radially outwardly farther than
the body 700, driving the head into the bone will compress the
suture strands as shown in a provisionally locked state. In this
state, the sutures will not slip easily but a user can supply
sufficient force to the ends 780, 782 to overcome the frictional
provisional lock and perform a final tensioning of the suture
strands 776. The plunger 750 is shown aligned with the passage 708
ready to be inserted after final tensioning of the suture strands
776 is completed.
Referring to FIG. 19, the plunger 750 has been inserted partway
into the passage 708 so that the suture ends 780 passing through
the proximal aperture pair are locked but the suture ends 782
passing through the distal aperture pair can still be tensioned if
desired. In this way the plunger 750 provides a sequential locking
action relative to the proximal and distal apertures.
Referring to FIG. 20, the plunger 750 has been fully seated locking
all of the suture strands and the loose suture ends have been cut
off flush with the bone.
FIG. 21 illustrates an alternative method of using the implant 700
in which separate suture strands are passed through separate
portions of a soft tissue and the loose ends of each strand are
secured using the distal and proximal pairs of apertures
respectively. A first suture strand 800 is attached to the rotator
cuff 778 such as by way of a mattress stitch or other suitable
stitch. The ends 802 of the first suture strand 800 have been
passed through the distal apertures 710, 712 of the implant body
700. A second suture strand 804 is attached to the rotator cuff 778
such as by way of a mattress stitch or other suitable stitch. The
ends 806 of the second suture strand 804 have been passed through
the proximal apertures 714, 716 of the implant body 700. The
implant body 700 is inserted into the bone tunnel 772 and the
sutures tensioned and secured as describe in the previous
illustrative example.
The foregoing examples have illustrated various embodiments of
devices and methods useful to attach an elongated strand to a bone
by forming a tunnel through the bone, passing the strand through
the bone, and then capturing both ends of the strand with a single
implant. The embodiments have been illustrated in use to repair a
rotator cuff of a shoulder joint but it will be understood that the
devices and methods are applicable at other surgical sites to
attach other implant and tissues to bone. For example, the devices
and methods may be used to attach sutures, tendons, ligaments,
cables, implant anchor portions, and/or other objects to bone at
surgical locations throughout a patient's body. The devices and
methods have been shown in use with first and second transverse,
linear, intersecting bone tunnels. However, the devices may be used
with single linear tunnels through a bone, curved tunnels, three or
more intersecting bone tunnels, and/or other bone tunnel
configurations in which it is desired to lock with a single device
multiple suture ends.
In the illustrative examples, anchors have been shown securing
suture portions at various locations of the anchor. For example,
some of the examples have described or depicted fixation at a
proximal portion of the anchor and/or at a distal portion of the
anchor. The proximal and distal portions of the anchor may refer to
distinct proximal and distal ends of the anchor. The proximal and
distal portions may refer to relative regions of the anchor such as
the proximal one half and distal one half of the anchor, the
proximal one third and distal two thirds of the anchor, the
proximal two thirds and distal one third or the anchor, or some
other fractional part referring to distinct relative zones.
The different illustrative examples have been shown with various
forms of bone fixation including threads and annular ridges of
varying size and shape. These different forms of fixation may be
interchanged within the scope of the invention. For example, where
ridges are shown, threads may be substituted and where threads are
shown, ridges may be substituted. Any other form of fixation known
in the art may also be substituted including but not limited to a
smooth press fit.
Some of the illustrative examples have included a plunger
receivable within an implant body to lock a suture portion relative
to the implant body. In these illustrative examples, the plunger
has been shown as engaging the implant body for axial translation
by threading, ratcheting, or smooth press fitting into the implant
body. These engagement arrangements may be interchanged among the
different plunger embodiments. Furthermore, other features for
retaining the plunger within the implant body may be incorporated
on the plunger and/or within the implant body including ridges,
grooves, bumps, surface textures, and/or other retaining features.
Furthermore, while the illustrative examples have depicted plungers
that are moveable from a proximal position to a distal position in
which the suture portion is secured, the plunger may also be
moveable from a distal position to a proximal position in which the
suture portion is secured. For example, a plunger may be disposed
in the implant body distal to a transverse opening and be pulled
proximally to secure a suture in the transverse opening.
* * * * *
References